tbuckley/cabot-search huggingface dataset:
Abstract 15713: A Novel Chest Pain Pathway Triaging Low-Risk Emergency Department Patients via Ambulatory Care Reduces Hospital Admissions Without Increased 30-Day Readmissions or All-Cause Mortality
Authors: Rohin K Reddy, Brian X. Wang, Bethany Gwyther, Turja Chakraborty, Diana Toia, Clemency Britton, Jun Yu Chen, Mohammad Farez Sayfoo, Arissa James, Faria Ashraf A Khan, Jagadeep Thapa, Balaji Gothandaraman
Journal: Circulation (2022)

Introduction: Chest pain is a common presentation to the Emergency Department (ED). Current international guidelines emphasise the importance of triage pathways involving patient-centric algorithms. In 2019, a front-door ED pathway (Figure 1) was created to direct low-risk chest pain towards ambulatory care. We aimed to characterise clinical outcomes with this pathway in a real-world UK ED cohort presenting with cardiac chest pain. Methods: The chest pain pathway stratified patients as low-, intermediate- and high-risk at presentation. Patients presenting to the ED at our institution in London, UK, were consecutively included in two groups: a pre-pathway group prior to implementation of the chest pain pathway and a post-pathway group following implementation. Baseline demographics were compared using Pearson’s χ 2 test for categorical variables and unpaired t-tests for continuous variables. Primary endpoints were 30-day readmissions, and all-cause mortality. Multiple logistic regression models were constructed to assess the impact of the pathway on the primary outcomes, adjusting for age, sex, risk category and HEART score. Results: Baseline demographics were similar between pre-pathway and post-pathway groups, except for presence of a smoking history ( p = 0.04). Smoking was therefore adjusted for in multivariable analyses. Approximately 10% (13/136) of post-pathway patients avoided hospital admission and were triaged towards ambulatory care. There was no significant difference in 30-day readmissions: 18/139 post-pathway vs 12/167 pre-pathway (OR 1.79, 95% CI 0.79 - 4.22, p = 0.17); or all-cause mortality: 2/167 pre-pathway vs 5/139 post-pathway (OR 2.96, 95% CI 0.49 - 25.68, p = 0.26). Conclusions: This novel chest pain pathway demonstrated a 10% reduction in hospital admissions without concurrent increases in 30-day readmissions or all-cause mortality. This is likely to reduce burdens on hospital resources and patient flow whilst maintaining safety.
Abstract 15490: The Association Between Measurements of Body Composition and the Prevalence of Hypertension, Diabetes and Dyslipidemia in Patients Without Coronary Artery Disease
Authors: Rosana G Bianchettin, Betsy Medina-Inojosa, Mohammad Ali Sheffeh, Andrea De Leon, Sha Lei, Lynne A Johnson, Farzane Saeidifard, Audry Chacin Suarez, Jose R Medina-Inojosa, Francisco Lopez-Jimenez
Journal: Circulation (2022)

Background: The body Mass Index (BMI) is commonly used in clinical practice to screen for obesity and resulting cardiometabolic conditions. Nonetheless, BMI has limited utility as it cannot differentiate body fat (BF). Hypothesis: We tested the hypothesis that BF content measured by air displacement plethysmography (Bod-Pod®) had a stronger association with prevalent hypertension (HTN), diabetes mellitus (DM) and dyslipidemia (DLP) when compared to BMI. Methods: We performed a community-based cross-sectional study on adults attending an employee wellness center from January 2007-December 2011 who had had a body composition assessment with Bod-Pod®. We excluded subjects with history of myocardial infarction, coronary artery disease, congestive heart failure, stroke at baseline. The prevalence of HTN, DM and DLP was assessed across quartiles of BF% and BMI categories. Their association with BF% and BMI was evaluated using linear regression models that adjusted for age, sex, and white race. Results: We included 3,052 individuals; 68 % were women, and the mean age ± SD was 42.09±12.8, BMI was 27.9±6.2; BF% 31.88±10.69, 892 (29.2%) were obese by BMI. Cardiometabolic conditions were prevalent in 496 (16.2%) with HTN, 378 (12.4%) with DM and 743 (24.4%) with DLP. While the prevalence of DM, HTN and DLP increased across BF% quartiles (all p for linearity&gt;0.01), this was not always the case across BMI categories (p for linearity&lt;0.05 for HTN and DLP, and 0.04 for DM) see Figure A . Elevated BF %, better identified individuals with HTN (AUC 0.766 vs 0.625; p&lt;0.001), DM (AUC 0.643 vs. 0.568; p&lt;0.001), DLP (AUC 0.758 vs. 0.593; p&lt;0.001). Conclusion: BF content is better associated with a higher prevalence of HTN, DM, and DLP. Highlighting the role of body composition assessment in primary prevention. Dyslipidemia.
Abstract 15733: Investigation of Cerebral Vessel Geometric Morphometrics for Prediction of Mechanical Thrombectomy First Pass Outcome
Authors: Briana Santo, S. Mostafa M M. J. Sarayi, Ammad Baig, Andre Monteiro, Muhammad Waqas, Adnan H Siddiqui, Vincent M Tutino
Journal: Circulation (2022)

Introduction: Vessel tortuosity is a major factor in successful first pass outcomes for mechanical thrombectomy (MT), but prior methods to quantify tortuosity are not accurate enough to predict outcome. We investigated a new method for vessel characterization and outcome prediction based on geometric morphometrics (GMM). Hypothesis: Our hypothesis was that morphometric analysis of engineered centerline landmarks would identify vessel characteristics that can better predict first pass MT outcome. Methods: Vessels and clots were manually segmented and reconstructed from pre-treatment CTA and nCCT images ( n =5 cases) (Fig. 1A). The vasculature corresponding to the ICA and MCA from the affected hemisphere was isolated, and centerlines were engineered as curved landmarks. MorphoJ, a GMM software, was used to complete generalized Procrustes and principal component (PC) Analysis that included registration of patient geometries, calculation of average morphology and landmark variation, and identification of anatomical landmarks differentiating MT outcomes (Fig. 1B). Morphometrics were compared against local and overall tortuosity by measuring the separability of and cohesion within outcome classes. Results: GMM produced two PCs, which described local variation in M1 (PC1) and the ICA (PC2) (Fig. 1B). When compared against vessel tortuosity features, GMM PCs increased the distance between outcome classes (first pass effect vs. no first pass effect), improving separability by 23.6%. Further, GMM PCs increased the compactness/cohesion of outcome classes, reducing cumulative distance between failures by 50% and successes by 9.4% (Fig. 1C). Conclusions: GMM analysis of pre-treatment vessel characteristic highlights regional variation in M1 as a strong indicator of MT failure and suggests that GMM has the potential to better predict MT outcome than ICA tortuosity alone. Investigation of more complex vessel morphometry through feature engineering is needed.
Abstract 267: Differences Of Temporal Trends In Outcomes After Out-of-hospital Cardiac Arrest Between Urban And Rural Regions In Japan: A 4-year Observational Study From 2016 To 2019
Authors: Akira Funada, Yoshikazu Goto
Journal: Circulation (2022)

Introduction: Recently, multiple studies have demonstrated improvement in survival after out-of-hospital cardiac arrest (OHCA). However, outcomes after OHCA vary with region and city worldwide. Hypothesis: Differences of temporal trends in outcomes after OHCA between rural and urban regions in Japan were postulated. Methods: We included 98,496 patients (aged ≥18 years) using an All-Japan Utstein-style Registry who were witnessed by bystanders after OHCA of presumed cardiac origin between January 1, 2016 and December 31, 2019. Based on population density, patients were classified into urban (n=76,411, 28 prefectures with a population of ≥200 inhabitants/km 2 ) and rural (n=22,085, 19 prefectures with a population of &lt;200 inhabitants/km 2 ) groups. The study endpoints were 1-month survival and neurologically intact survival, defined with a cerebral performance category (CPC) score of 1 or 2. Results: The mean age in rural regions significantly increased from 77.1 years to 77.8 years ( P &lt;0.01) despite unchanged patients’ age in urban regions for 4 years ( P =0.45). The bystander cardiopulmonary resuscitation (B-CPR) rate in urban regions significantly increased from 54.0% to 55.7% ( P &lt;0.01) unlike in rural regions ( P =0.45). The overall crude 1-month survival and CPC 1-2 rates during the study periods were 10.9% and 6.8%, respectively. The overall 1-month survival and CPC 1-2 rates significantly improved from 2016 to 2019; the corresponding risk-adjusted ratios per year were 1.04 [95% confidence interval (CI), 1.02-1.07, P &lt;0.01] and 1.03 [1.01-1.06, P &lt;0.05]. In the urban group, 1-month survival and CPC 1-2 rates significantly improved from 2016 to 2019; the corresponding risk-adjusted ratios per year were 1.05 [95% CI, 1.03-1.08, P &lt;0.01] and 1.04 [1.01-1.07, P &lt;0.01]. However, in the rural group, 1-month outcomes did not significantly improve from 2016 to 2019; the corresponding risk-adjusted ratios per year were 0.99 [95% CI, 0.95-1.04, P =0.68] and 1.01 [0.95-1.07, P =0.74]. Conclusions: One-month outcomes after OHCA significantly improved over the recent 4 years in urban regions, unlike in rural regions in Japan. No change in B-CPR rate in rural regions was noted, and an increase in the B-CPR rate in urban regions may be associated with these results.
Abstract 15873: Trends, Predictors, and Cardiovascular Outcomes Among Primary vs Secondary Takotsubo Syndrome - Nationwide Inpatient Sample Analysis
Authors: yasar sattar, Anoop Titus, Izza Shahid, David Song, Muhammad Z Khan, Akhil Jain, Shoaib Ashraf, Mariam Jalil, Samian Sulaiman, Muhammad U Khan, sudarshan balla
Journal: Circulation (2022)

Introduction: Takotsubo Syndrome (TTS), also known as stress-induced cardiomyopathy can be primary/idiopathic or secondary to physical stressor including acute illness. There is limited data on cardiovascular outcomes among primary TTS (pTTS) and secondary (sTTS). Methods: The National Inpatient Sample from the year 2016 to 2019 was queried to assess outcomes in pTTS and sTTS. The primary outcome was all-cause mortality, and secondary outcomes were acute kidney injury (AKI) heart failure (HF), stroke, cardiogenic shock (CS), and sudden cardiac arrest (SCA).We did trend analysis of outcomes, length of stay (LOS) and inflation adjusted hospital charges. The primary analysis used was pearson chi-Square, linear regression, and multivariate matching using STATA 17MP. Results: A total of 158,715 patients (pTTS n= 57,560 (38%); sTTS n= 101,155 (62%)). The cohorts were female predominant. On univariate and chi-square linear regression, we found higher odds and incidence of all-cause mortality, AKI, heart failure, and stroke in sTTS as compared to pTTS. After matching for confounding variables, all-cause mortality (OR 1.3; CI 1.1 - 1.56; p &lt; 0.001), and AKI (OR 1.10; CI 1.03 - 1.03; p &lt; 0.001) was still high in sTTS, but interestingly HF (OR 0.93; CI 0.88 - 0.99 ; p = 0.023), stroke (aOR 0.50; CI 0.43-0.59; p &lt; 0.001), and MCS (aOR 0.61; CI 0.47-0.79; p &lt; 0.001) were lower in sTTS as compared to pTTS. There was no difference in CS and SCA between pTTS and sTTS. Self-pay and prior CABG were most predictive of mortality for sTTS. Yearly trend analysis showed an uptrend for all non-HF outcomes in both pTTS and sTTS, a stable trend for HF, while trends showed higher incidence of CS in sTTS as compared to pTTS. Mean LOS and inflation adjusted hospital charges were higher in sTTS compared to pTTS. Conclusions: sTTS have worse cardiovascular outcomes as compared to pTTS and associated with higher inflation adjusted hospital charges and length of stay likely due to critical underlying primary illness.
Abstract 15632: Rv Dysfunction and the Risk of Mortality in Cardiomyopathy Patients Who Suffered a Cardiac Arrest
Authors: Effimia Zacharia, Filip Istvanic, Samir Saba
Journal: Circulation (2022)

Background: Right ventricular (RV) dysfunction has been associated with higher mortality in patients who suffer a cardiac arrest. However, the role of RV dysfunction in patients with known cardiomyopathy (CM) (EF&lt;50%) who suffer cardiac arrest from a shockable rhythm is not well examined. Aim: To assess the relationship between RV dysfunction and mortality in patients with cardiac arrest from a shockable rhythm without an ICD. Methods: We included patients with CM of any etiology who were hospitalized for the first time with cardiac arrest at a tertiary care center between 2011 and 2017. We examined in-hospital as well as long-term mortality. RV dysfunction was defined based on standard echo parameters. Results: A total of 208 patients were admitted to the hospital with cardiac arrest from a shockable rhythm (VT/VfIb) and 139 of those had no ICD at the time of the cardiac arrest. Out of those 139 patients, 48 had RV dysfunction. Patients with RV dysfunction had higher in-hospital mortality (44.7% vs 15.1%, p&lt;.001). Over a mean follow-up of 2.9±3.2 years, patients with RV dysfunction had higher long-term mortality rates (72.9 vs 53.8%, p=.029) as well as shorter mean survival time (33.2, CI [20.6-45.8], vs 66.0 [53-78.9] months, p=0.005, Figure). In a Cox regression model, patients with RV dysfunction had higher long-term mortality rates when adjusting for EF, initiation of new AAD, electrolyte abnormalities and new ischemia (HR 1.68, 95% CI [1.05-2.69], p=.028). During hospitalization, patients with RV dysfunction needed advanced HF treatment options (inotropes, OHT) more frequently compared to patients without RV dysfunction (70.8 vs 46.2%, p=.005). Conclusions: RV dysfunction is an independent predictor of mortality in patients with cardiac arrest from a shockable rhythm who do not have an ICD. Further studies should investigate whether the presence of RV dysfunction alone should be taken into consideration for decisions on ICD implantation in patients with CM.
Abstract 15654: Mitral Valve Strands in a Patient With Cerebellar Infarcts
Authors: Supraja Achuthanandan, Nikhil Cordeiro, Amit Dhaliwal, Adnan Sadiq
Journal: Circulation (2022)

Case Description: A 56-year-old man with a history of hypertension, diabetes, hyperlipidemia, and ischemic stroke 2 years ago presented with left-sided weakness, unsteady gait, and vomiting for 12 hours. The patient was vitally stable, and examination revealed dysarthria, left ataxic hemiparesis, and chronic right facial droop. Magnetic Resonance Imaging (MRI) brain showed an evolving acute infarct in the left superior cerebellum with trace petechial hemorrhage, chronic small right posterior inferior cerebellar infarct, and chronic bilateral cerebellar lacunar infarcts. The patient had an implantable loop recorder placed after his previous stroke, which did not show any arrhythmias on interrogation. MRI Angiography of the head/neck did not show large vessel occlusions. Transesophageal echocardiography (TEE) ruled out a patent foramen ovale but did reveal multiple filamentous structures (&lt;5mm in size) on the atrial side of the posterior mitral valve leaflet (figure 1); these were consistent with fibrin valve strands, or Lambl’s excrescences (LE). Anticoagulation therapy was started, and surgical excision was recommended. Discussion: LE are rare fibrous/filamentous valvular strands caused by wear and tear at the closure lines of left-sided heart valves. LE can be associated with thromboembolic strokes and acute coronary syndromes; however, it can also be found incidentally. TEE is the gold standard in diagnosis. This is a middle-aged man without a clear cause of ischemic strokes, subsequently found to have LE on the mitral valve. There is a paucity of evidence on the management of LE due to its rarity. Prior case reports suggest the use of antiplatelets/anticoagulants in symptomatic patients and surgery in cases of recurrent thromboembolic episodes refractory to conservative treatment. Given multiple strokes, this patient was started on anticoagulation and will be evaluated for surgery. Further high-powered studies are needed to guide management.
Abstract 184: Symptoms And Functional Impairment Among First Aid Providers
Authors: Anna Marie Moe Oevsteboe, Conrad A Bjorshol, Thomas Werner Lindner
Journal: Circulation (2022)

Symptoms and Functional Impairment among First Aid Providers Øvstebø AMM, Bjørshol CA, Lindner TW. Introduction: A first aid provider (FAP) follow-up program was initiated in Norway in 2020. FAPs are people who have been present or provided first aid to an unconscious person. The aim was to measure symptoms and functional impairments of FAPs following first aid incidents, and change over time. Hypothesis: Our hypothesis was that FAPs have significant psychological impairment. Methods: FAPs filled out an International Trauma Questionnaire (ITQ) at follow-up and after 6 months. ITQ focuses on core features of post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD). Endorsement of a symptom or functional impairment is defined as a score ≥ 2 (scale 0-4).The number of FAPs with a score ≥ 2 were counted for each question, and the five questions with the highest count were identified. We found the number of FAPs attending after more than 31 days who met the criteria of PTSD and CPTSD. Results were compared using Wilcoxon Signed Ranks test. Results: 63 of 75 (84%) FAPs scored ≥ 2 on at least one question. ITQ questions with highest count, and no. of answers ≥ 2 (%): Being “super-alert”, watchful, or on guard: 34 of 75 (45%). Affected any other important part of your life: 32 of 75 (43%). Avoiding internal reminders of the experience: 31 of 75 (41%). Having powerful images or memories that sometimes come into your mind: 29 of 75 (39%). Affected your work or ability to work: 27 of 75 (36%). Five of 24 FAPs (21%) who attended more than 31 days after the incident fulfilled the criteria of PTSD/CPTSD. Median ITQ score when attending follow-up was 12.0, this was significantly reduced to 9.0 at 6 months (n =23, p=0.047). Conclusions: A high number of FAPs have endorsement of a symptom or functional impairment. Some meet the criteria for PTSD or CPTSD after more than 31 days. There was a significant reduction in ITQ score after 6 months. This might be a result of FAP follow-up.
Abstract 15525: Resolving Human Sinoatrial Node Leading Pacemaker vs Atrial Early Activation Sites by 3D High Resolution Imaging to Guide Ablation Treatment of Atrial Arrhythmia
Authors: Ning Li, Brian Hansen, Anuradha Kalyanasundaram, James Kennelly, Peter J Mohler, Orlando Simonetti, Jichao Zhao, John Hummel, Vadim V Fedorov
Journal: Circulation (2022)

Introduction: Surgical/ablation treatment for atrial arrhythmias such as anatomic sinoatrial node (SAN) tachycardia and atrial fibrillation either target or preserve the SAN. However, defining SAN is challenging because clinical electrophysiological (EP) mapping can visualize only exits of SAN activation as early activation sites (EAS) and not the leading pacemaker (LP) within the 3D intramural SAN. Methods: High resolution (300-900μm 2 ) including epi/endocardial (Epi/Endo) dual sided near infrared optical mapping (NIOM) was conducted on coronary perfused explanted human atria (n=26, 19-69 y.o.). SAN was defined by optical action potential morphologies as the region of slow diastolic depolarization (slow upstroke) preceding atrial excitation. Serial histology and contrast enhanced MRI (CE-MRI, 100μm 3 resolution) were used to define the 3D fibrotic structure of the SAN pacemaker complex. Results: During sinus rhythm (SR) (83±22 bpm), the LP was primarily located in the SAN center. Electrical impulses exit from SAN to atria through 1-2 sinoatrial conduction pathways (SACP), leading to discrete EAS along crista terminalis (CT), preferentially from lateral superior/middle SACPs. The distance between SAN LP and EAS varied from 3.5-23 mm. Heterogeneous atrial wall thickness, fibrosis content and myofiber orientation along the SAN and CT (5-15mm thick) regions led to complex intramural conduction from SAN LP to EAS and substantial Epi-Endo activation dyssynchrony. Conclusions: EAS visualized on both Epi/Endo mapping mainly distributed along thick CT, but not on the surface projection of SAN, due to intramural fiber orientation of preferential SACPs. The higher fibrotic content in the human SAN than CT detected by CE-MRI, integrated with EP mapping can be helpful to accurately define SAN structure and pathways for reentrant SAN arrhythmias ablations.
Abstract 15606: Diabetes is Associated With Increased Risk of Major Adverse Cardiovascular Events in Patients Covid-19: A Retrospective U.S. Multicenter Cohort Study
Authors: Candrika D Khairani, Antoine Bejjani, Brett Carroll, James Welker, Marc P Bonaca, Judith A Hsia, Samuel Z Goldhaber, Gregory Piazza
Journal: Circulation (2022)

Introduction: Diabetes mellitus (DM) increases the risk of adverse outcomes in patients with COVID-19. Whether this is driven by a higher rate of thrombotic complications or cardiovascular events in patients with COVID-19 has rarely been explored. Methods: We analyzed a retrospective cohort of 6920 consecutive patients ≥ 18 years old with confirmed SARS-COV-2 polymerase chain reaction testing from March 2020 to April 2020 using a US multicenter registry. Main outcomes of interest were 30-day of adjudicated major adverse cardiovascular events (MACE), major arterial and venous thromboembolic (VTE) events, and symptomatic VTE. MACE included VTE, catheter related thrombosis, myocardial infarction, stroke, major adverse limb events, heart failure hospitalization, atrial fibrillation (AF), and myocarditis. Results: Of 1252 patients with DM, 49.4% were women, 50.9% were non-white, and 26.2% were Latinx. Mean BMI of patients with and without DM was similar (34.2 vs 33.4 kg/m2, p =0.91). Compared with patients without DM, those with DM were older (50.3±15.4 years. vs 39.6±19.7, p &lt;0.001), had higher rates of hypertension, AF, hospitalization (76.4% vs 23.1%, 5.0% vs 1.0% and 60.8% vs 28.4%, p &lt;0.001, respectively). Thirty days after COVID diagnosis, patients with DM had a higher rate of MACE (12.7% vs 3.9%, p &lt;0.001), major arterial or venous thromboembolism (8.5% vs 3.1%, p &lt;0.001), symptomatic VTE (6.5% vs 4.7%, p &lt;0.001 ), and death (11.9% vs 4.7%, p &lt;0.001) compared with patients without DM (Panel A). After adjusting for age, gender, hypertension, COVID-19 admission, peripheral artery disease, and coronary artery disease, patients with DM had increased risk of MACE (aOR 1.39 95% CI 1.09-1.78), but not of major adverse arterial or VTE events (aOR 1.24 95% CI 0.93-1.65), symptomatic VTE (aOR 1.34 95% CI 0.98-1.86), or death (aOR 1.13 95% CI 0.87-1.47) (Panel B). Conclusions: In patients with COVID-19, DM is independently associated with increased risk of MACE.